DeFede

Somewhere inside county hall, the president of the Public Health Trust had decided it was better to stay out of sight during the county commission's annual budget hearing than to step forward and defend his agency's spotty record for meeting the medical needs of Miami-Dade's indigent community.

People kept asking, "Where's Ira?" Several commissioners openly called for Clark or any representative of the Public Health Trust to come forward. At one point in the meeting, it appeared that County Manager Merrett Stierheim's neck would break as he twisted and turned in his seat, scouring the audience for any sign of the president. The Houdini act seemed rather absurd because everyone knew Clark was in the building. Numerous people saw him there. But as soon as the commission's discussion turned to his agency, he disappeared faster than the last bottle of Viagra at a convention of geriatric nymphomaniacs.

While Clark's actions were curious, they were still very much in character.

You see Ira Clark does not stand before mere county commissioners and defend his use of the public's money. Ira Clark is far too self-important to degrade himself in such a banal exercise of democracy. Ira Clark is much more comfortable exerting power and influence in the shadows of governance, away from the harsh glare of public scrutiny.

The Public Health Trust operates Jackson Memorial Hospital and for years has reaped the benefit of a half-penny increase to the sales tax. With a budget of nearly one billion dollars, it is one of the best financed public-health agencies in the nation. Yet throughout this county, there are glaring gaps in service. For years county commissioners have repeatedly asked the trust to live up to its responsibilities to the community and do more. County Commissioner Katy Sorenson, for instance, has pleaded with the trust to adequately fund a clinic in South Miami-Dade so that residents there could receive 24-hour emergency attention. The cost: $1.9 million.

Every year Clark and the members of the Public Health Trust tell Sorenson they'll take care of the clinic and every year nothing happens. Well, this year that changed and it has touched off a royal battle.

Rather than waiting again for the trust to take action, Sorenson and her fellow commissioners stepped in, seized the money, and allocated it to the clinic themselves. And that was only the beginning. Led by County Commissioner Miguel Diaz de la Portilla, the commission mandated that the trust spend $1.7 million to provide insurance for all 8900 children on the waiting list for a preventative care program known as Healthy Kids. The commission also ordered the trust to pick up the cost of providing health care for jail inmates, an expense that costs the county commission $11.5 million per year. Why spend money from the county's general fund on health care for prisoners, Diaz de la Portilla asked, when those funds can be used to improve the quality of life of everyone else in Miami-Dade County? Besides, since most inmates are indigent, Diaz de la Portilla noted, it only makes sense that the Public Health Trust should pay for their care.

Diaz de la Portilla then took the $11.5 million now freed up inside the county budget and made it available for a slew of worthwhile county programs. Some of that money will be used to clean up and dredge the Miami River; $4 million will be spent developing programs and activities for children in local parks; the grass along county roads and medians will be cut more often; additional crews will be hired to clear vacant lots of debris and abandoned cars; new inspectors will be hired to track down unlicensed contractors; and $2 million will be allocated to cultural grants. The list goes on and on.

This year's budget hearing was without question one of Diaz de la Portilla's finest moments as a commissioner. And if it came at the expense of the Public Health Trust and Ira Clark, so be it. Last week the Herald criticized the commission for raiding the trust's piggy bank, even though the trust has more than $300 million in reserves. The Herald's criticism was not unexpected. The paper is fond of sacred cows, and they don't come any more pious than the trust and its members, a veritable who's who of the county's business community.

If the county commission deserves any criticism, it's that it didn't step in sooner. The trust needed the swift kick in the ass that the commission provided. My only fear is that the commission is going to revert to its old habit of ignoring the trust now that the budget process is over. Ira Clark and the Public Health Trust need to be dragged -- kicking and screaming if necessary -- back into this community.

Even with the few measures the county commission now requires the trust to finance, there is plenty to do.

Daniella Levine, the executive director of the Human Services Coalition, says the trust has "left itself vulnerable to allegations that they are not meeting indigent needs when they have such a large reserve of cash at a time when there are so many needs going unmet."

Joe Greer, the medical director of Camillus House, is even more blunt. "I think it is an embarrassment that we live in a community where so many people are not being taken care of and the Public Health Trust is just sitting on hundreds of millions of dollars that it refuses to spend," he says. "How can you justify that? How is that acceptable?"

Why isn't the trust, for instance, doing more to set up school-based health clinics? Why isn't it doing more to counter the spread of AIDS in this community? What type of outreach does the trust have in place to serve migrant farm workers in South Miami-Dade?

Plainly stated the biggest problem with the trust is that its members, by and large, are mindless sheep who for years have done whatever Clark wanted them to do. There is a prestige that comes with sitting on the trust, and it appears that many simply want the title of "board member" but aren't really interested in any of the responsibilities that come with it. "They have a very earnest but compliant board," says Katy Sorenson, who has been one of the commission's representatives to the trust for the past two years. "There is no doubt, though, that Ira Clark runs the board. All of their decisions are very carefully orchestrated by Ira Clark and the hospital's staff."

Last week Sorenson met with trust board members following the commission's raid on its budget. Sorenson made it clear the commission's action was appropriate because the trust had shirked its responsibilities. As a result the trust withdrew a resolution that would have asked the mayor to veto the budget. I'm sure most trust members hope the entire affair will quickly fade from public view.

The time, however, seems right for a communitywide debate about the role of the trust. And the commission needs to play an active and aggressive part. People sometimes forget that the Public Health Trust was created by the county commission and its rules and procedures are spelled out in the Code of Metropolitan Dade County. Specifically those rules are outlined in Section 25A, and it might do both the members of the trust and the county commission good to read them sometime. For instance the code states that

the Trust shall submit recommendations to the County Commission for annual and long range, five-year plans for the delivery of countywide health care services....

It continues:

The Trust shall formally present its annual countywide planning recommendations ... at an annual, joint meeting to be called by the Chairperson of the Board of County Commissioners and to be held between the Commission and the Trust no later than July 1st of each year.

In the seven years I've been covering the county commission, I cannot recall a single joint meeting between the commission and the trust. They just don't happen. And that should change. The trust should be required to justify its existence and describe its long-range planning. There should be an annual joint meeting between the entire county commission and all the members of the trust in which those long-range plans are discussed, and the public should have an opportunity to comment on those plans. That meeting should be broadcast on the county's cable television station. For that matter why aren't all of the trust's monthly meetings being broadcast? It's time to shed a little light on the trust.

And if the members of the trust need some incentive, perhaps they should read the portion of Section 25A that states:

The Board of County Commissioners shall, after examining the Trust's annual report and accounting, determine whether there is net income ... at the end of the fiscal year. The Board of County Commissioners may then appropriate such net income into the County's general revenues or leave such net income with the Trust for continued use in effecting the public purposes of the Trust; however, in the event the Commissioners decide to leave such income with the Trust, the Commissioners shall still retain the right to withdraw such income at any future time.

It sounds to me that the county commission has the authority to draw even more from those reserves. Perhaps Ira Clark should think about that the next time he decides to play a game of hide-and-seek with commissioners.